MEDICARE WILL PAY FOR SUPERVISED EXERCISE THERAPY FOR PAD PATIENTS
February 18, 2019
Medicare recently issued guidance on providing supervised exercise therapy (in the form of physical therapy) for patients with peripheral artery disease (PAD). (copy attached)
Patients will be covered for up to 36 sessions over a 12-week period if all of the following conditions are met:
• The sessions consist of exercise lasting 30-60 minutes for PAD in patients with claudication;
• The therapy is conducted in a physician’s office or hospital outpatient setting (not a private PT practice);
• The therapy is delivered by qualified staff (which includes physical therapists); and
• The therapy is under the direct (in the building) supervision of a physician, physician assistant or nurse practitioner who is trained in both basic and advanced life support techniques. (Supervision by a PA or NP will result in payments at 85% of the regular fee schedule, so it is best to opt for physician supervision if available.)
Download PDF: MLM on Exercise Therapy Released Feb 2019
Patients must first have a face-to-face visit with the physician responsible for PAD treatment to obtain the referral for supervised exercise therapy. At this visit, the patient must receive information regarding cardiovascular disease and PAD risk reduction, which can include education, counseling, behavioral interventions, and outcome assessments.
This supervised exercise therapy should be billed using CPT code 93668 with one of the following ICD-10 codes:
